Graves, NicholasHiller, JanetBarnett, Adrian G.Gardner, AnneMitchell, Brett G.2023-11-012023-11-012014-02-012013-12-08<p>Mitchell, B., Gardner, A., Barnett, A., Hiller, J., & Graves, N. (2014). The prolongation of length of stay because of <em>Clostridium difficile</em> infection.<em> American Journal of Infection Control, 42</em>(2), 164-167. doi:10.1016/j.ajic.2013.07.006</p>0196-6553https://doi.org/10.1016/j.ajic.2013.07.006https://research.avondale.edu.au/handle/123456789/04898129<p><h4 id="x-x-x-x-x-x-x-x-x-x-absSec_1">Background</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0010"><em>Clostridium difficile</em> infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_2">Methods</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0015">We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_3">Results</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0020">One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: −1.8 to 3.6 days, <em>P</em> = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42; <em>P</em> < .001) when a Cox proportional hazard model was applied. <h4 id="x-x-x-x-x-x-x-x-x-x-absSec_4">Conclusion</h4> <p id="x-x-x-x-x-x-x-x-x-x-abspara0025">This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.</p>en-us<p>Due to copyright restrictions this article is unavailable for download.</p> <p>Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier, Inc. All rights reserved.</p> <p>Staff and Students of Avondale College may access this article from library PRIMO search <a href="http://www.avondale.edu.au/library">here.</a></p>clostridium difficilelength of staymultistate modelinfection controlJournal Article